A Clinical Study Of Laryngeal Function Preservation For Secondary Operation In Recurrent Laryngeal Carcinoma

Purpose:To study the feasibility and effectiveness of laryngeal function preservation for secondary operation in recurrent laryngeal carcinoma.Methods:A total of 72 cases with intact data of recurrent laryngeal carcinoma after partial laryngectomy were retrospectively analyzed in our department from Feb 1998 to Aug 2003,68 cases of males and 4 females, age 35-68 years old,the average age of 57.6 years old.All cases were laryngeal squamous cell carcinoma local recurrence after surgery,16 patients with ipsilateral or contralateral neck lymph node metastasis, one of 52 cases of glottic(T1N0M0 24 Example,T2N0M0 16 Example,T2N1M0 8 Example,T3N2M0 4 cases),20 cases of supraglottic(T1N0M0 10 Example, T2N0M0 4 Example,T2N1M0 2 Example,T3N0M0 2 Example,T3N1M0 2 cases). The patients were divided into two groups based on different surgical methods:group with reservation of laryngeal function(group A,n=42), after the resection of recurrent tumor along 0.5-1 cm' s safe margins, the plasty of new laryngeal cavity were performed successfully by means of suturing local mucosa,piatysma-myocutaneous flap,epiglottic flap, tongue flap et al,Cricohyoidopexy was also applied in partial patients; group with no laryngeal function(group B,n=30),total laryngectomy were performed in this group.The1,3,5-year survival rate and incidence of recurrence were analyzed after the procedures.Results:ALL the cases of group A were recovered with laryngeal partial or total function.(1) respiratory function:35 cases successful extubation in 1-3 mouths,5 cases extubation after 1-3 times CO2 laser surgery,while two cases of failed extubation;(2) Voice function:all patients returned to normal voice,five cases of patients with hoarseness were found forming part of a small amount of granulation growth;(3) swallowing function:All patients had restoration of swallowing function in 1-4 weeks,2-4 weeks diet training can be good for obvious choking, aspiration phenomenon in 6 cases of cricohyoidopexy.The cases of group B lost speech function.No severe complications were discovered in two groups.The follow-up time was more than 5 years,5 cases of loss follow-up,the follow-up rate was 93.1%.There were no statistical significant between group A and group B in the1,3,5-year survival rate and incidence of recurrence(92.9%VS 93.3%,71.4%VS 73.3%,50.0%VS 53.3%,35.7%VS 33.3%,respectively;P＞0.05).Conclusion:1.By the statistics,two sets of data analysis without statistical significance.2.Neck dissection:NO stage,patients experienced radiation therapy will be decided whether the neck dissection is needed based on pathology and the scope of the carcinoma;Without radiotherapy,the initial surgery require ipsilateral neck dissection,if the cleaning had been done the contralateral neck dissection will be needed;N-positive,if the lesions did not exceed the center line,the radical or modified radical neck dissection will be needed,if the lesions over the central line,the cleaning of the contralateral side should be done selectively,focusing on LevelⅡ-Ⅲ;For the contralateral cases of lymph node metastasis, contralateral radical or modified radical neck dissection is needed and the ipsilateral selective neck dissection should be done simultaneously.3.Postoperative radiotherapy:For the initial post-operative radiotherapy in patients with non- radiotherapy,after 1-1.5 months, radiotherapy,radiation dose to cure amount(60-70Gy) is appropriate.4.The results showed that:For carefully selected cases,such as recurrence of lesions confined to patients younger than 70 years old,and in the throat,except to the widespread violations of tumor recurrence, no cavity forming may be persons,distant metastasis and dysfunction,such as cardio-pulmonary cases,laryngeal function preservation for secondary operation in recurrent laryngeal carcinoma was proved to be feasible.